Abstract

Background

In 2004, a practice charge for physician visits ('Praxisgebuehr') was implemented
in the German health care system, mainly in order to reduce expenditures of sickness
funds by reducing outpatient physician visits. In the statutory sickness funds, all
adults now have to pay € 10 at their first physician visit in each 3 month period,
except for vaccinations and preventive services. This study looks at the effect of
this new patient fee on delaying or avoiding physician visits, with a special emphasis
on different income groups.

Methods

Six representative surveys (conducted between 2004 and 2006) of the Bertelsmann Healthcare
Monitor were analysed, comprising 7,769 women and men aged 18 to 79 years. The analyses
are based on stratified analyses and logistic regression models, including a focus
on the subgroup having a chronic disease.

Results

Two results can be highlighted. First, avoiding or delaying a physician visit due
to this fee is seen most often among younger and healthier adults. Second, those in
the lowest income group are much more affected in this way than the better of. The
multivariate analysis in the subgroup of respondents having a chronic disease shows,
for example, that this reaction is reported 2.45 times more often in the lowest income
group than in the highest income group (95% CI: 1.90–3.15).

Conclusion

The analyses indicate that the effects of the practice charge differ by socio-economic
group. It would be important to assess these effects in more detail, especially the
effects on health care quality and health outcomes. It can be assumed, however, that
avoiding or delaying physician visits jeopardizes both, and that health inequalities
are increasing due to the practice charge.